Coronal (image 1) and axial (image 2) contrast enhanced CT o | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Coronal (image 1) and axial (image 2) contrast enhanced CT obtained in a child with neuroblastoma shows a large left neuroblastoma (arrowhead). The tumor crosses midline, partially encases the aorta, and extends into the inferior vena cava (arrow). There is also diffuse involvement of the pancreas (dashed arrow). Vascular invasion in patients with neuroblastoma is incredibly uncommon. More typically, neuroblastoma uplifts, displaces, and encases vessels. #TummyTuesday #AbdomenTuesday

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\ Axial contrast-enhanced CT of the abdomen (image 1) shows the large retroperitoneal mass (arrow) uplifting the abdominal aorta (arrowhead). There are diffuse bone metastases with an abnormal appearance of the vertebral bodies on the sagittal CT of the spine (image 2). MIBG scan (image 3) shows bone metastases involving the calvarium, humeri, ribs, spine, pelvis, and femurs. The imaging findings are consistent with neuroblastoma. Neuroblastoma most commonly arises from the adrenal glands. It displaces and uplifts vessels. Neuroblastoma most commonly metastasizes to bone, bone marrow, and the liver.

\ Image description\ Axial (image 1) and coronal (image 2) contrast-enhanced CT shows a large left renal mass (arrow) that crosses midline and circumferentially encases the abdominal aorta (arrowhead). A thin rim of renal parenchyma is preserved at the tumor periphery. Post-therapy coronal T2-weighted MRI (image 3) shows interval decrease in tumor size.\ Teaching point\ Primary renal neuroblastoma is rare and can mimic Wilms tumor. Vascular encasement without narrowing and extension across midline favor neuroblastoma. Identification of residual peripheral renal parenchyma suggests origin within the kidney rather than adrenal displacement.

\ Longitudinal color Doppler US of the same patient 3 weeks later shows decrease in size of the avascular suprarenal mass (white arrow). Continued follow-up showed further decrease with gradual calcification, typical of a neonatal adrenal hemorrhage. Other suprarenal masses in a newborn include neuroblastoma & extralobar pulmonary sequestration. Internal vascularity would favor neuroblastoma, as would interval growth on short-term follow-up imaging (which is generally a reasonable approach as many small congenital neuroblastomas will undergo spontaneous regression). #FridayQuizDay

\ AP (image 1) and lateral (image 2) radiograph if the distal femur shows an aggressive bone tumor with periosteal new bone formation (arrows), a Codman triangle (arrow on lateral view), and a permeative appearance of the bone. On the lateral view, there is a large soft tissue mass (arrowhead). This patient was later diagnosed with neuroblastoma as seen on the MIBG scan (image 3). Skeletal uptake (double-sided arrow) is never normal on MIBG scans and is indicative of metastatic disease. Liver metastases are also present as the liver is enlarged and has diffuse uptake of the radiopharmaceutical. Neuroblastoma most commonly metastasizes to bone, bone marrow, and the liver.#MSKMonday